=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306469317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARE ALPHA CHIROPRACTIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2020
-----------------------------------------------------
Last Update Date | 05/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1426 N MCEWAN ST
-----------------------------------------------------
City | CLARE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48617-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-386-3446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1426 N MCEWAN ST
-----------------------------------------------------
City | CLARE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48617-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-386-3446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOEL JORDAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 989-386-3446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------